Faculty Bibliography

OBJECTIVE:Induction of labor (IOL) and hospitalist coverage is becoming more common. While hospitalist coverage has been associated with improved maternal outcomes and lower cesarean delivery rates, its impact on IOL remains unclear. The objective of this study was to compare the induction time to vaginal delivery across three obstetric coverage models: hospitalists, faculty generalists, and private practice generalists. STUDY DESIGN/METHODS:This single-site retrospective cohort study analyzed singleton, term (≥39 weeks), vertex patients undergoing induction of labor at NYU Langone Hospital- Long Island from January 1 to September 30, 2022. Hospitalists at this institution managed high-risk obstetric patients including those under maternal-fetal medicine care, resident clinic, and unregistered patients who presented to labor and delivery, along with serving as labor and delivery safety officer on the labor floor. Faculty and private practice generalists managed their respective groups. Outcomes included induction time to vaginal delivery, mode of delivery, induction methods, and maternal and neonatal complications. Statistical analyses included chi-square, ANOVA, and multivariable linear regression. A p-value <0.05 was statistically significant. RESULTS:Among 403 patients, 92 (22.8%) were managed by hospitalists, 115 (28.5%) by faculty, and 196 (48.6%) by private generalists. Median (IQR) induction-to-delivery times were similar across groups-hospitalists 20.5 (15.3-27.5) h, faculty 23.4 (16.5-31.1) h, and private 19.7 (14.1-25.6) h (p = 0.004). However, when limited to vaginal deliveries, no significant difference was observed in induction-to-vaginal-delivery time (p = 0.17). Private generalists had the shortest induction-to-cesarean time and time to membrane rupture leading to cesarean. There were no differences in intrapartum complications. Hospitalists had more NICU admissions after vaginal delivery, mostly unrelated to labor. CONCLUSION/CONCLUSIONS:Induction-to-vaginal delivery times and complication rates were similar across coverage models, but differences in NICU admissions and cesarean delivery times highlight care variations. Collaboration and evidence based standardized induction protocols may optimize outcomes across coverage models.

This study aimed to assess factors impacting obstetric triage time to disposition. The primary and secondary hypotheses were that high-risk patients and patients evaluated during periods with less staffing would experience prolonged length of stay (LOS), respectively.This single-site, retrospective cohort study analyzed 9,704 obstetric triage visits of 6,182 patients between January 1, 2022, to February 28, 2023. Inclusion criteria included patients 18 years or older with one or more evaluations. Exclusion criteria included scheduled admissions, unknown chief complaints, triage time under 10 minutes, and patients under 18 years old. A total of 6,612 visits representing 4,390 patients were included. The visits were stratified by disposition: admission versus nonadmission (transfer or discharge). Descriptive statistics analyze continuous variables. Frequencies and percentages were calculated for categorical variables. SAS was used for chi-square or Fisher's exact test for categorical variables and the two-sample t-test or Mann-Whitney test for continuous data. Statistical significance was p-value < 0.05.Of 6,612 visits, 3,475 admissions, and 3,137 nonadmissions occurred. The most common chief complaints were contractions (42%), amniotic fluid index evaluation (18%), and preeclampsia evaluation (8%). Admitted compared with nonadmitted patients had shorter LOS (64 minutes vs. 185 minutes, p < 0.001). Admitted compared with nonadmitted patients had shorter LOS by chief complaint, gestational age, high-risk maternal-fetal medicine status, time of day, and day of the week (all p < 0.001).Nonadmitted, maternal-fetal medicine and preterm patients evaluated during daytime and weekdays had significantly longer LOS. Vulnerable populations and target times for triage workflow improvement were identified. · Patient and unit factors influenced LOS.. · Nonadmitted patients had triple the LOS.. · High-risk patients had longer LOS.. · Daytime and weekday visits had longer LOS..

Neuromolecular Imaging (NMI) with novel biosensors enables the selective detection of neurotransmitters in vivo within seconds, on line and in real time. Biosensors remain in place for continuing studies over a period of months. This biotechnological advance is based on conventional electrochemistry; the biosensors detect neurotransmitters by electron transfer. Simply stated, biosensors adsorb electrons from each neurotransmitter at specific oxidation potentials; the current derived from electron transfer is proportional to neurotransmitter concentration. Selective electron transfer properties of these biosensors permit the imaging of neurotransmitters, metabolites and precursors. The novel BRODERICK PROBE(R) biosensors we have developed, differ in formulation and detection capabilities from biosensors/electrodes used in conventional electrochemistry/ voltammetry. In these studies, NMI, specifically, the BRODERICK PROBE(R) laurate biosensor images neurotransmitter signals within mesolimbic neuronal terminals, nucleus accumbens (NAc); dopamine (DA), serotonin (5-HT), homovanillic acid (HVA) and Ltryptophan (L-TP) are selectively imaged. Simultaneously, we use infrared photobeams to monitor open-field movement behaviors on line with NMI in the same animal subjects. The goals are to investigate integrated neurochemical and behavioral effects of cocaine and caffeine alone and co-administered and further, to use ketanserin to decipher receptor profiles for these psychostimulants, alone and co-administered. The rationale for selecting this medication is: ketanserin (a) is an antihypertensive and cocaine and caffeine produce hypertension and (b) acts at 5-HT2A/2C receptors, prevalent in NAc and implicated in hypertension and cocaine addiction. Key findings are: (a) the moderate dose of caffeine simultaneously potentiates cocaine's neurochemical and behavioral responses. (b) ketanserin simultaneously inhibits cocaine-increased DA and 5-HT release in NAc and open-field behaviors and (c) ketanserin inhibits 5-HT release in NAc and open-field behaviors produced by caffeine, but, surprisingly, acts to increase DA release in NAc. Importantly, the latter effect may be a possible adverse effect of the moderate dose of caffeine in hypertensive patients. Thus, an antihypertensive medication is shown here to play a role in inhibiting brain reward possibly via antihypertensive mechanisms at DA and 5-HT receptor subtypes within DA motor neurons. An explanatory note for the results obtained, is the role likely played by the G Protein Receptor Complex (GPRC) family of proteins. Empirical evidence shows that GPRC dimers, heteromers and heterotrimers may cause cross-talk between distinct signalling cascade pathways in the actions of cocaine and caffeine. Ligand-directed functional selectivity, particularly for ketanserin, in addition to GPRCs, may also cause differential responses. The results promise new therapeutic strategies for drug addiction, brain reward and cardiovascular medicine.